Metabolic Syndrome is Associated with Increased Postoperative Morbidity and Hospital Resource Utilization in Patients Undergoing Elective Pancreatectomy
Purpose In patients undergoing elective partial pancreatectomy, our aim was to evaluate the effect of metabolic syndrome (MS) on postoperative mortality, morbidity, and utilization of hospital resources. Our hypothesis was that MS is associated with worse surgical outcomes after pancreatectomy. Meth...
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| Veröffentlicht in: | Journal of gastrointestinal surgery 2016-01, Vol.20 (1), p.189-198 |
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| creator | Tee, May C. Ubl, Daniel S. Habermann, Elizabeth B. Nagorney, David M. Kendrick, Michael L. Sarr, Michael G. Truty, Mark J. Que, Florencia G. Reid-Lombardo, KMarie Smoot, Rory L. Farnell, Michael B. |
| description | Purpose
In patients undergoing elective partial pancreatectomy, our
aim
was to evaluate the effect of metabolic syndrome (MS) on postoperative mortality, morbidity, and utilization of hospital resources. Our
hypothesis
was that MS is associated with worse surgical outcomes after pancreatectomy.
Methods
Fifteen thousand eight hundred thirty-one patients undergoing elective pancreatectomy from 2005 to 2012 were identified in the Participant User File of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Univariable and multivariable analyses were performed examining the association of MS (defined as body mass index ≥30 kg/m
2
, hypertension requiring medications, and diabetes requiring medications and/or insulin) and risk of 30-day mortality, morbidity, and utilization of hospital resources (risk of blood transfusion in the first 72 h after pancreatectomy and prolonged hospital stay, defined as ≥13 days, which was the 75th percentile of this cohort). Multivariable logistic regression models controlled for age, sex, race, pancreatectomy type (distal versus proximal), smoking status, alcohol consumption, functional status, dyspnea, cardiovascular disease, hematocrit, INR, serum albumin, bilirubin, and creatinine. Stratified analyses were conducted by type of pancreatectomy and indication for pancreatectomy (benign versus malignant).
Results
On univariate analysis, 1070 (6.8 %) patients had MS. MS was associated with increased postoperative morbidity, major morbidity, surgical site infection, septic shock, cardiac event, respiratory failure, pulmonary embolism, blood transfusion, and prolonged duration of hospital stay (
P
|
| doi_str_mv | 10.1007/s11605-015-3007-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1783909403</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1783909403</sourcerecordid><originalsourceid>FETCH-LOGICAL-c442t-cfdad94aa755b147b24aba64313cc4a9f1650a5111203731ba1e0ceabec206c13</originalsourceid><addsrcrecordid>eNp1kV1rVDEQhg9isbX6A7yRgDfeHJvJx_m4LKXaQouLuuBdmJMzu6ack6xJVll_iT_XtFtFCr2aeckz72R4q-oV8HfAeXuSABquaw66lkXX_ZPqCLpW1qoRzdPS8x5qofXXw-p5SjecQ8uhe1YdikZrKZr2qPp9TRmHMDnLPu_8GMNMzCV2mlKwDjON7KfL39ilt5EwFbkIKYcNRczuB7HrEAc3urxj6Ed2EdLGZZzYJ0phGy2xZXaT-1XY4JnzbFE68jmxpR8proPza3Y-kb3zWuDdklxkmHcvqoMVTole3tfjavn-_MvZRX318cPl2elVbZUSubarEcdeIbZaD6DaQSgcsFESpLUK-xU0mqMGAMFlK2FAIG4JB7KCNxbkcfV277uJ4fuWUjazS5amCT2FbTLQdrLnveKyoG8eoDflSl9-Vygt-q5QXaFgT9kYUoq0MpvoZow7A9zcxmb2sZkSm7mNzfRl5vW983aYafw38TenAog9kMqTX1P8b_Wjrn8A42Gl-w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1752989408</pqid></control><display><type>article</type><title>Metabolic Syndrome is Associated with Increased Postoperative Morbidity and Hospital Resource Utilization in Patients Undergoing Elective Pancreatectomy</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Tee, May C. ; Ubl, Daniel S. ; Habermann, Elizabeth B. ; Nagorney, David M. ; Kendrick, Michael L. ; Sarr, Michael G. ; Truty, Mark J. ; Que, Florencia G. ; Reid-Lombardo, KMarie ; Smoot, Rory L. ; Farnell, Michael B.</creator><creatorcontrib>Tee, May C. ; Ubl, Daniel S. ; Habermann, Elizabeth B. ; Nagorney, David M. ; Kendrick, Michael L. ; Sarr, Michael G. ; Truty, Mark J. ; Que, Florencia G. ; Reid-Lombardo, KMarie ; Smoot, Rory L. ; Farnell, Michael B.</creatorcontrib><description>Purpose
In patients undergoing elective partial pancreatectomy, our
aim
was to evaluate the effect of metabolic syndrome (MS) on postoperative mortality, morbidity, and utilization of hospital resources. Our
hypothesis
was that MS is associated with worse surgical outcomes after pancreatectomy.
Methods
Fifteen thousand eight hundred thirty-one patients undergoing elective pancreatectomy from 2005 to 2012 were identified in the Participant User File of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Univariable and multivariable analyses were performed examining the association of MS (defined as body mass index ≥30 kg/m
2
, hypertension requiring medications, and diabetes requiring medications and/or insulin) and risk of 30-day mortality, morbidity, and utilization of hospital resources (risk of blood transfusion in the first 72 h after pancreatectomy and prolonged hospital stay, defined as ≥13 days, which was the 75th percentile of this cohort). Multivariable logistic regression models controlled for age, sex, race, pancreatectomy type (distal versus proximal), smoking status, alcohol consumption, functional status, dyspnea, cardiovascular disease, hematocrit, INR, serum albumin, bilirubin, and creatinine. Stratified analyses were conducted by type of pancreatectomy and indication for pancreatectomy (benign versus malignant).
Results
On univariate analysis, 1070 (6.8 %) patients had MS. MS was associated with increased postoperative morbidity, major morbidity, surgical site infection, septic shock, cardiac event, respiratory failure, pulmonary embolism, blood transfusion, and prolonged duration of hospital stay (
P
< 0.05 for all analyses). After controlling for potentially confounding variables, there was a 26 % increased odds of postoperative morbidity (
P
< 0.001), 17 % increased odds of major morbidity (
P
= 0.034), 32 % increased odds of surgical site infection (
P
< 0.001), 34 % increased odds of respiratory failure (
P
= 0.023), 68 % increased odds of pulmonary embolism (
P
= 0.045), 26 % increased odds of blood transfusion (
P
= 0.018), and 21 % increased odds of prolonged hospital stay (
P
= 0.011) in patients with MS compared to patients without MS. MS was not associated with 30-day mortality after elective pancreatectomy (
P
= 0.465). When stratified by distal versus proximal pancreatectomy and benign versus malignant disease, the effect of MS on outcomes appears to be modified by type of pancreatectomy and indication with poorer outcomes observed for distal pancreatectomies and benign indications for resection.
Conclusion
MS is an under-emphasized predictor of increased postoperative morbidity and utilization of hospital resources in patients undergoing elective pancreatectomy. The effect of MS on these postoperative outcomes appears to be more pronounced for patients with benign rather than malignant indications for pancreatectomy and in patients undergoing distal rather than proximal pancreatectomy. These results may inform patient selection, optimization of comorbidities prior to elective pancreatectomy, and strategies for postoperative management.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-015-3007-9</identifier><identifier>PMID: 26553267</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>2015 SSAT Plenary Presentation ; Aged ; Blood Transfusion ; Blood transfusions ; Body mass index ; Elective Surgical Procedures ; Female ; Gastroenterology ; Hospitals ; Humans ; Hypertension ; Length of Stay ; Logistic Models ; Male ; Medicine ; Medicine & Public Health ; Metabolic syndrome ; Metabolic Syndrome - complications ; Middle Aged ; Morbidity ; Mortality ; Obesity ; Pancreatectomy - mortality ; Patient Selection ; Postoperative Care ; Postoperative Complications ; Postoperative period ; Pulmonary embolisms ; Quality improvement ; Respiratory failure ; Risk Factors ; Surgeons ; Surgery ; Surgical outcomes ; Surgical site infections</subject><ispartof>Journal of gastrointestinal surgery, 2016-01, Vol.20 (1), p.189-198</ispartof><rights>The Society for Surgery of the Alimentary Tract 2015</rights><rights>The Society for Surgery of the Alimentary Tract 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-cfdad94aa755b147b24aba64313cc4a9f1650a5111203731ba1e0ceabec206c13</citedby><cites>FETCH-LOGICAL-c442t-cfdad94aa755b147b24aba64313cc4a9f1650a5111203731ba1e0ceabec206c13</cites><orcidid>0000-0002-8087-5522</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-015-3007-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-015-3007-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26553267$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tee, May C.</creatorcontrib><creatorcontrib>Ubl, Daniel S.</creatorcontrib><creatorcontrib>Habermann, Elizabeth B.</creatorcontrib><creatorcontrib>Nagorney, David M.</creatorcontrib><creatorcontrib>Kendrick, Michael L.</creatorcontrib><creatorcontrib>Sarr, Michael G.</creatorcontrib><creatorcontrib>Truty, Mark J.</creatorcontrib><creatorcontrib>Que, Florencia G.</creatorcontrib><creatorcontrib>Reid-Lombardo, KMarie</creatorcontrib><creatorcontrib>Smoot, Rory L.</creatorcontrib><creatorcontrib>Farnell, Michael B.</creatorcontrib><title>Metabolic Syndrome is Associated with Increased Postoperative Morbidity and Hospital Resource Utilization in Patients Undergoing Elective Pancreatectomy</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>Purpose
In patients undergoing elective partial pancreatectomy, our
aim
was to evaluate the effect of metabolic syndrome (MS) on postoperative mortality, morbidity, and utilization of hospital resources. Our
hypothesis
was that MS is associated with worse surgical outcomes after pancreatectomy.
Methods
Fifteen thousand eight hundred thirty-one patients undergoing elective pancreatectomy from 2005 to 2012 were identified in the Participant User File of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Univariable and multivariable analyses were performed examining the association of MS (defined as body mass index ≥30 kg/m
2
, hypertension requiring medications, and diabetes requiring medications and/or insulin) and risk of 30-day mortality, morbidity, and utilization of hospital resources (risk of blood transfusion in the first 72 h after pancreatectomy and prolonged hospital stay, defined as ≥13 days, which was the 75th percentile of this cohort). Multivariable logistic regression models controlled for age, sex, race, pancreatectomy type (distal versus proximal), smoking status, alcohol consumption, functional status, dyspnea, cardiovascular disease, hematocrit, INR, serum albumin, bilirubin, and creatinine. Stratified analyses were conducted by type of pancreatectomy and indication for pancreatectomy (benign versus malignant).
Results
On univariate analysis, 1070 (6.8 %) patients had MS. MS was associated with increased postoperative morbidity, major morbidity, surgical site infection, septic shock, cardiac event, respiratory failure, pulmonary embolism, blood transfusion, and prolonged duration of hospital stay (
P
< 0.05 for all analyses). After controlling for potentially confounding variables, there was a 26 % increased odds of postoperative morbidity (
P
< 0.001), 17 % increased odds of major morbidity (
P
= 0.034), 32 % increased odds of surgical site infection (
P
< 0.001), 34 % increased odds of respiratory failure (
P
= 0.023), 68 % increased odds of pulmonary embolism (
P
= 0.045), 26 % increased odds of blood transfusion (
P
= 0.018), and 21 % increased odds of prolonged hospital stay (
P
= 0.011) in patients with MS compared to patients without MS. MS was not associated with 30-day mortality after elective pancreatectomy (
P
= 0.465). When stratified by distal versus proximal pancreatectomy and benign versus malignant disease, the effect of MS on outcomes appears to be modified by type of pancreatectomy and indication with poorer outcomes observed for distal pancreatectomies and benign indications for resection.
Conclusion
MS is an under-emphasized predictor of increased postoperative morbidity and utilization of hospital resources in patients undergoing elective pancreatectomy. The effect of MS on these postoperative outcomes appears to be more pronounced for patients with benign rather than malignant indications for pancreatectomy and in patients undergoing distal rather than proximal pancreatectomy. These results may inform patient selection, optimization of comorbidities prior to elective pancreatectomy, and strategies for postoperative management.</description><subject>2015 SSAT Plenary Presentation</subject><subject>Aged</subject><subject>Blood Transfusion</subject><subject>Blood transfusions</subject><subject>Body mass index</subject><subject>Elective Surgical Procedures</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Length of Stay</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic syndrome</subject><subject>Metabolic Syndrome - complications</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Obesity</subject><subject>Pancreatectomy - mortality</subject><subject>Patient Selection</subject><subject>Postoperative Care</subject><subject>Postoperative Complications</subject><subject>Postoperative period</subject><subject>Pulmonary embolisms</subject><subject>Quality improvement</subject><subject>Respiratory failure</subject><subject>Risk Factors</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Surgical site infections</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kV1rVDEQhg9isbX6A7yRgDfeHJvJx_m4LKXaQouLuuBdmJMzu6ack6xJVll_iT_XtFtFCr2aeckz72R4q-oV8HfAeXuSABquaw66lkXX_ZPqCLpW1qoRzdPS8x5qofXXw-p5SjecQ8uhe1YdikZrKZr2qPp9TRmHMDnLPu_8GMNMzCV2mlKwDjON7KfL39ilt5EwFbkIKYcNRczuB7HrEAc3urxj6Ed2EdLGZZzYJ0phGy2xZXaT-1XY4JnzbFE68jmxpR8proPza3Y-kb3zWuDdklxkmHcvqoMVTole3tfjavn-_MvZRX318cPl2elVbZUSubarEcdeIbZaD6DaQSgcsFESpLUK-xU0mqMGAMFlK2FAIG4JB7KCNxbkcfV277uJ4fuWUjazS5amCT2FbTLQdrLnveKyoG8eoDflSl9-Vygt-q5QXaFgT9kYUoq0MpvoZow7A9zcxmb2sZkSm7mNzfRl5vW983aYafw38TenAog9kMqTX1P8b_Wjrn8A42Gl-w</recordid><startdate>20160101</startdate><enddate>20160101</enddate><creator>Tee, May C.</creator><creator>Ubl, Daniel S.</creator><creator>Habermann, Elizabeth B.</creator><creator>Nagorney, David M.</creator><creator>Kendrick, Michael L.</creator><creator>Sarr, Michael G.</creator><creator>Truty, Mark J.</creator><creator>Que, Florencia G.</creator><creator>Reid-Lombardo, KMarie</creator><creator>Smoot, Rory L.</creator><creator>Farnell, Michael B.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8087-5522</orcidid></search><sort><creationdate>20160101</creationdate><title>Metabolic Syndrome is Associated with Increased Postoperative Morbidity and Hospital Resource Utilization in Patients Undergoing Elective Pancreatectomy</title><author>Tee, May C. ; Ubl, Daniel S. ; Habermann, Elizabeth B. ; Nagorney, David M. ; Kendrick, Michael L. ; Sarr, Michael G. ; Truty, Mark J. ; Que, Florencia G. ; Reid-Lombardo, KMarie ; Smoot, Rory L. ; Farnell, Michael B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c442t-cfdad94aa755b147b24aba64313cc4a9f1650a5111203731ba1e0ceabec206c13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>2015 SSAT Plenary Presentation</topic><topic>Aged</topic><topic>Blood Transfusion</topic><topic>Blood transfusions</topic><topic>Body mass index</topic><topic>Elective Surgical Procedures</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Length of Stay</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic syndrome</topic><topic>Metabolic Syndrome - complications</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Obesity</topic><topic>Pancreatectomy - mortality</topic><topic>Patient Selection</topic><topic>Postoperative Care</topic><topic>Postoperative Complications</topic><topic>Postoperative period</topic><topic>Pulmonary embolisms</topic><topic>Quality improvement</topic><topic>Respiratory failure</topic><topic>Risk Factors</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Surgical site infections</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tee, May C.</creatorcontrib><creatorcontrib>Ubl, Daniel S.</creatorcontrib><creatorcontrib>Habermann, Elizabeth B.</creatorcontrib><creatorcontrib>Nagorney, David M.</creatorcontrib><creatorcontrib>Kendrick, Michael L.</creatorcontrib><creatorcontrib>Sarr, Michael G.</creatorcontrib><creatorcontrib>Truty, Mark J.</creatorcontrib><creatorcontrib>Que, Florencia G.</creatorcontrib><creatorcontrib>Reid-Lombardo, KMarie</creatorcontrib><creatorcontrib>Smoot, Rory L.</creatorcontrib><creatorcontrib>Farnell, Michael B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tee, May C.</au><au>Ubl, Daniel S.</au><au>Habermann, Elizabeth B.</au><au>Nagorney, David M.</au><au>Kendrick, Michael L.</au><au>Sarr, Michael G.</au><au>Truty, Mark J.</au><au>Que, Florencia G.</au><au>Reid-Lombardo, KMarie</au><au>Smoot, Rory L.</au><au>Farnell, Michael B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Metabolic Syndrome is Associated with Increased Postoperative Morbidity and Hospital Resource Utilization in Patients Undergoing Elective Pancreatectomy</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2016-01-01</date><risdate>2016</risdate><volume>20</volume><issue>1</issue><spage>189</spage><epage>198</epage><pages>189-198</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract>Purpose
In patients undergoing elective partial pancreatectomy, our
aim
was to evaluate the effect of metabolic syndrome (MS) on postoperative mortality, morbidity, and utilization of hospital resources. Our
hypothesis
was that MS is associated with worse surgical outcomes after pancreatectomy.
Methods
Fifteen thousand eight hundred thirty-one patients undergoing elective pancreatectomy from 2005 to 2012 were identified in the Participant User File of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Univariable and multivariable analyses were performed examining the association of MS (defined as body mass index ≥30 kg/m
2
, hypertension requiring medications, and diabetes requiring medications and/or insulin) and risk of 30-day mortality, morbidity, and utilization of hospital resources (risk of blood transfusion in the first 72 h after pancreatectomy and prolonged hospital stay, defined as ≥13 days, which was the 75th percentile of this cohort). Multivariable logistic regression models controlled for age, sex, race, pancreatectomy type (distal versus proximal), smoking status, alcohol consumption, functional status, dyspnea, cardiovascular disease, hematocrit, INR, serum albumin, bilirubin, and creatinine. Stratified analyses were conducted by type of pancreatectomy and indication for pancreatectomy (benign versus malignant).
Results
On univariate analysis, 1070 (6.8 %) patients had MS. MS was associated with increased postoperative morbidity, major morbidity, surgical site infection, septic shock, cardiac event, respiratory failure, pulmonary embolism, blood transfusion, and prolonged duration of hospital stay (
P
< 0.05 for all analyses). After controlling for potentially confounding variables, there was a 26 % increased odds of postoperative morbidity (
P
< 0.001), 17 % increased odds of major morbidity (
P
= 0.034), 32 % increased odds of surgical site infection (
P
< 0.001), 34 % increased odds of respiratory failure (
P
= 0.023), 68 % increased odds of pulmonary embolism (
P
= 0.045), 26 % increased odds of blood transfusion (
P
= 0.018), and 21 % increased odds of prolonged hospital stay (
P
= 0.011) in patients with MS compared to patients without MS. MS was not associated with 30-day mortality after elective pancreatectomy (
P
= 0.465). When stratified by distal versus proximal pancreatectomy and benign versus malignant disease, the effect of MS on outcomes appears to be modified by type of pancreatectomy and indication with poorer outcomes observed for distal pancreatectomies and benign indications for resection.
Conclusion
MS is an under-emphasized predictor of increased postoperative morbidity and utilization of hospital resources in patients undergoing elective pancreatectomy. The effect of MS on these postoperative outcomes appears to be more pronounced for patients with benign rather than malignant indications for pancreatectomy and in patients undergoing distal rather than proximal pancreatectomy. These results may inform patient selection, optimization of comorbidities prior to elective pancreatectomy, and strategies for postoperative management.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>26553267</pmid><doi>10.1007/s11605-015-3007-9</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-8087-5522</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1091-255X |
| ispartof | Journal of gastrointestinal surgery, 2016-01, Vol.20 (1), p.189-198 |
| issn | 1091-255X 1873-4626 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1783909403 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | 2015 SSAT Plenary Presentation Aged Blood Transfusion Blood transfusions Body mass index Elective Surgical Procedures Female Gastroenterology Hospitals Humans Hypertension Length of Stay Logistic Models Male Medicine Medicine & Public Health Metabolic syndrome Metabolic Syndrome - complications Middle Aged Morbidity Mortality Obesity Pancreatectomy - mortality Patient Selection Postoperative Care Postoperative Complications Postoperative period Pulmonary embolisms Quality improvement Respiratory failure Risk Factors Surgeons Surgery Surgical outcomes Surgical site infections |
| title | Metabolic Syndrome is Associated with Increased Postoperative Morbidity and Hospital Resource Utilization in Patients Undergoing Elective Pancreatectomy |
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